How the Repeal of Obamacare Will Further Weaken the Quality of US Healthcare

Repealing the ACA would shrink the customer base for insurance companies, which would respond by investing less in their product, says Donna Smith of the Progressive Democrats of America

MIKE PENCE: Obamacare has failed and the American people have sent a decisive message to Washington, D.C., that they want Obamacare to be repealed and replaced with healthcare reform that will lower the cost of health insurance, without broadening the size of government. We’re working very closely with the Senate leadership on a budget resolution that will begin the process of repealing Obamacare, and also create a framework for a replacement going forward.

KIM BROWN: Repeal and replace Obamacare — that has been a consistent promise coming from Congressional Republicans virtually since the Affordable Care Act was signed into law in 2010. So, what will be the impact on the millions of Americans who obtained healthcare under the ACA, should it be repealed? Or, could repeal possibly be a blessing in disguise? Maybe clearing the way for an even improved healthcare system under a possible new administration in 2020.

And with us here to discuss this, we’re joined by Donna Smith. Donna is the Executive Director of the Progressive Democrats of America. She was formerly a legislative advocate for the California Nurses’ Association. Donna, welcome back.

DONNA SMITH: Thank you so much. It’s good to be on.

KIM BROWN: Well, Donna, let’s walk down a couple of different roads here, because there’s a lot to unpack, in the possibility of the ACA, or Obamacare, possibly being repealed under this new Republican-controlled Congress, and with President-elect Donald Trump about to be inaugurated to the White House.

So, let’s start with Mike Pence’s comments which were backed up by House Speaker Paul Ryan on Thursday, who vowed that a repeal of Obamacare would be swift. Meaning that he said that it would be coming this year, but a replacement won’t come until “later”. But the problem is the GOP has been making this promise for a long while. Donna, what are your thoughts about this most recent, at least rhetorical, attempt to say that Obamacare will be repealed and replaced?

DONNA SMITH: Well, this is one of these situations, I think, the Republicans find themselves in — it’s pray for a Cadillac, you better step back from the curb. You know, they have now really legitimately… they have to deliver on this promise that they’ve been making for many years, virtually since the Act was passed in 2010. They’ve been promising to repeal, and they’ve been voting to repeal. And now that they have both Houses of Congress, and they have a Republican incoming President, they feel as though, and probably do for their base, have to make good on this promise.

That is not necessarily what the majority of American people want, but it is what the Republican Party intends to deliver. I think what they’re finding out very, very rapidly, is that it isn’t such an easy thing to say that you’re going to repeal this law, that’s very intricately intertwined now with our healthcare system in this country. And it’s going to be a much more difficult process than they bargained for.

KIM BROWN: Well, Donna, I looked into some archives, and as you said, the GOP has been promising to deliver on this repeal and replace for quite some time. So, let’s just confirm that. Let’s take a look at former Congressman, and I believe then-House Minority leader, Eric Cantor, in 2011.

ERIC CANTOR: Our next step is to fulfill our pledge to repeal the trillion dollar job-killing healthcare law that was rammed through Congress last year by the previous majority, despite the public outcry against it. This week I join Speaker Boehner and other key Republicans, in releasing a new report that documents how the healthcare law is destroying jobs and piling up more debt. It makes a compelling case for taking immediate action to repeal Obamacare, and replace it with reforms that will lower costs and protect jobs.

KIM BROWN: So, Donna let’s take a look, or at least take an analysis, at those six-year-old comments from Eric Cantor, who is no longer even in Congress anymore and neither is John Boehner, who was House Speaker at the time of these comments. But the points that they were making was that Obamacare will not only add to the national debt, but it will cost consumers more.

And we did see some evidence of that fairly recently. Late last year the Obama Administration did say that healthcare premiums would go up. So, are the increased costs for some who got covered under Obamacare, does that offset the amount of healthcare costs that they would have had if they were not covered under the ACA?

DONNA SMITH: That’s a great question, and fortunately or unfortunately for me, I am one of those examples. I am covered by a plan that I purchased on the exchange for myself, on the Obamacare exchange. And my costs, my premium costs, this year are going up 26% — which is very similar to what’s happening to a lot of people who are covered by plans that they bought on the ACA exchanges. So, the reality is, though, if I were not to have any coverage, if I did not have this coverage, I would not have access to coverage.

I’m a three-time cancer survivor. I’m 62 years old. So, it’s not as if there’s any insurance company that would really race to want to cover me, or millions of other people who get their coverage on the Affordable Care Act exchanges. So, this is a problem, you know, if we repeal the Affordable Care Act, and we don’t maintain some of the things that give coverage to millions of people who get it now — like the pre-existing condition clauses, like the guaranteed issue parts of the Affordable Care Act, like keeping people on their parents’ coverage until they’re 26, if that’s what they desire — then we will all… for me, for instance, I will have no coverage.

And, trust me, expensive coverage isn’t great. It isn’t what I want, but expensive coverage is better than no coverage. And I would suspect that most people who are in my shoes, and who are getting their coverage through the Affordable Care Act, probably feel very similar to what I do.

KIM BROWN: Well, Donna in what seems to be the unexpected, unconventional way of the incoming Trump Administration, they seem to be talking, literally, out of both sides of their neck. Because as we heard from Speaker Paul Ryan, at least we saw in the tweet, and he gave this at a press conference — and we just heard from Vice President-elect Mike Pence — saying one thing, but another member of the Trump transition team is saying something completely different. Let’s take a listen:

CHRIS COLLINS: So, immediately, what we’re saying is, we’re not going to pull the rug out from under anyone. There’s not going to be any changes in 2017. There’s not going to be changes in 2018. Those products have already been approved by the state insurance agencies, or for the 2018 timeline, are in negotiation right now.

So, we’re talking about new plans in 2019, or later, that will be more affordable, let patients pick their doctors. We’ll have to figure out exactly how we make sure that Americans are not disadvantaged. And that’s a promise we’ve made. We’re not going to pull the rug out from under anyone. So, there’s no reason to worry the next two years.

KIM BROWN: No reason to worry. That was Congressman Chris Collins, a Republican from New York who was part of Donald Trump’s transition team. So, who are we to believe here, Donna? Are we to believe one member of the Trump transition team, or his actual Vice President-elect? I don’t know who to believe.

DONNA SMITH: Well, let’s be realistic. Let’s say they do what many anticipate they will do, which is repeal and delay — meaning that they’ll vote in all that they need to do through budget reconciliation, and through other legislation — even through some Executive Orders from Donald Trump. They do all of that, but they delay implementation for at least past the next Congressional election, or even beyond that. Let’s say they do that. They say they’re not going to pull the rug out from anyone.

All right, let’s follow that with any business in this country that knew that its product base, its customer base, was going to be withdrawn or significantly reduced within a very short amount of time. How much investment do you suppose that most insurance companies will place in making sure they’re providing the best possible insurance coverage they can? If they know that that customer base is going to be significantly reduced in coming years?

I would suspect that we all know, just with common sense, that even if it is a repeal-and-delay implementation situation, the insurance giants are not going to invest in developing those products the way they would have, if they were still required to provide coverage under the rules of the Affordable Care Act.

KIM BROWN: So, Donna, hypothetically, if the GOP-controlled Congress with Donald Trump’s signature are able to repeal the ACA and not replace it with anything — just leaving the people covered under it, an estimated 20 million or so people have received coverage under the Affordable Care Act — in that limbo period, what would that mean for someone who was depending on having that coverage and they have it taken away, but don’t have anything to replace it?

DONNA SMITH: I think we could see some real disruption, of course, in healthcare services. And we ought not to forget, even though right now they’re talking about the 20 million people who get private insurance coverage through the ACA exchanges, we ought not to forget the Affordable Care Act also expanded Medicaid coverage and made so many more people eligible for coverage through Medicaid. And now the talk is that if Tom Price is confirmed as the HHS Secretary, that he very much is in favor of a block grant kind of system for Medicaid — which could seriously curtail and really interrupt the expansion of Medicaid that happened throughout this country.

So, we’re not talking about disruptions for just 20 million people — we’re talking about disruption of healthcare if the Republicans have their way and do what they’re promising to do. We’re talking about a disruption of healthcare to many, many more millions of people. It really could be quite tragic in going back to a period of time when people couldn’t access basic services that are now required under the Affordable Care Act — like the ability to get some screenings for cancer, and get some check-ups once a year, and to be able to get some coverage for medications and other needed things. The only way some people can afford those things is with the coverage they got through the ACA.

So, if we’re going to go back to the period where we have healthcare savings accounts, and where we allow a free market to operate in the health insurance marketplace — oh my gosh — I fear greatly for all the people who will, first of all, decide that they just can’t afford to get coverage, or can’t find it. And then we go back to a situation where the uninsured are really dying at a higher rate and certainly suffering at a higher rate, when in fact, you know, there’s no need to do any of this.

There really is no need, beyond an ideological and ridiculous effort on the Republicans’ part, to really go after this law, ever since 2009, when we were really starting to talk about it.

KIM BROWN: So, Donna, it doesn’t appear to be a solid, a whole consensus, among at least the Senate Republicans, on whether or not they will vote to repeal the Affordable Care Act. Senator Rand Paul, a Republican of Kentucky, who was just re-elected this past year, he has come out and said that he will vote against it. He will be, at least so far, the lone defection in the Republican caucus on this vote to repeal Obamacare because he says it will add to the national debt.

And it raises the possibility of whether or not some other Republicans could possibly join Rand Paul in defecting from the rest of their caucus, because they do have a majority in the Senate. But it would only take a handful of defectors to stop the repeal of Obamacare in its tracks. And you worked as a legislative advocate. You know stranger things have happened on the Hill. What do you think of the possibility that the Republicans can’t even muster their own caucus to get this done?

DONNA SMITH: Well, my hope is that there will be other Republicans in the Senate who have enough common sense that they put a halt to this, and they say, “Look, until we at least have a plan, a firm solid plan to put forward to consider.” It would be irresponsible, not only to the American public and the people who get their coverage, but think about all the changes that providers and businesses went through to comply with the basics of the Affordable Care Act.

There was a huge investment that American business made. That communities all across this country made, to be in compliance with the Affordable Care Act. Backing yourself away from all of those tenets is an expensive proposition. But there is a plan, and I hope that not only Rand Paul, but other Senators — I know Bernie Sanders knows this, and so too do a great number of Democratic Senators — they know that the best plan, if we were going to talk about replacing the Affordable Care Act, repealing it and replacing it, the most seamless, the most economical way to do that is to improve and expand Medicare to cover everyone.

It is a one single public risk pool. Every insurance person knows the bigger the risk pool, the more the risk is spread. It’s one single public risk pool that allows people private access to their doctors, their providers and to… Ask most Americans if they believe that Medicare is a good program, and they do. So, the Republicans — if they really want to ingratiate themselves as the people who improved our healthcare system, gave access to all Americans to affordable healthcare — the best way they could possibly do that is not by block granting Medicaid, voucher-izing, privatizing Medicare, repealing the Affordable Care Act, and doing ridiculous healthcare savings accounts or sales across state lines of insurance. The most economical way is for us to expand and improve Medicare to everyone. It would be seamless. It would be easier for everyone in this country to understand, and it would provide that… Talk about something that Republicans could really claim as a victory for themselves, that they helped and they moved us further along the path to healthcare justice.

They really could do that and they could accomplish the things that they want to accomplish, and ramping back costs for healthcare, and really doing something that the American people could embrace for many, many years to come.

KIM BROWN: Indeed, and that is a plan that was championed, as you mentioned, by Senator Bernie Sanders when he was seeking the Democratic nomination to be President — Medicare for All, expansion. Donna, if the Affordable Care Act is repealed and replaced, like you said, how likely is it that a Medicare for All program could come to be in the United States?

I mean, we’re the only industrialized Western nation that does not have this type of coverage for all of its citizens. And despite the overwhelming public opinion in favor of this type of healthcare plan for Americans, it doesn’t seem to happen. And do you think that in this climate right now, with President-elect Donald Trump coming to town, with a somewhat ornery Republican caucus and majority in Congress — how likely is it that a Medicare for All could be coming to all of us?

DONNA SMITH: If I had to gauge it right now, I’d say not very likely. However, we have to remember that, you know, just a very few short months ago none of us believed that Donald Trump could ever be elected President of the United States. And, you know, in elections past we didn’t believe that the results that happened could have possibly happened.

But right now we have an interesting situation, where we have enough Americans, a strong majority of Americans, of all political stripes, believe that a Medicare for All system would be better for this country than would be what the mess that we have now. Or going back to some mix of healthcare savings accounts and private coverage being purchased on open markets. A strong majority of Americans — an overwhelming majority of Democrats, as we might expect, but a strong majority of Americans — it’s hard to find very many issues where you can get such a strong majority of Americans all on the same page.

So, if these Republicans are really wanting to listen to the American public, and say, “We’re going to be responsive. We’re going to be responsive. We’re going to fix the problems in this healthcare system. We’re going to take a look at the Affordable Care Act and what things we liked about it,” and really compare it to what a Medicare for All system could do — not only for the American public, but for American business — imagine the power of that.

You know, Donald Trump keeps tweeting out about the various car companies and various industries that want to move operations across borders, either to Canada or to Mexico, to enjoy cheaper labor and so forth. Well, one of the reasons GM years ago decided that they would build cars in Canada, was it cost them at that time, an average of $1,100 per vehicle less, simply because of healthcare costs between the United States and Canada.

So, the reality is, American business would benefit from a Medicare for All. Is it likely to happen today in this Congress? No. But now that they’re saying that they want to repeal and delay, perhaps they should listen a little bit more to Rand Paul. Take a little step back. Tell the American public, “Yes, we intend to do something better than what the Affordable Care Act is. But we have some time now to sit down with everyone across both aisles. Sit down and talk about what’s the best thing for this country. Not only for American business, but the American public and for the economy as a whole.”

And once you really take a look at that, Medicare for All just laps every other kind of conversation you can have, and gives us what we want.

KIM BROWN: And there it is. That’s Donna Smith. She’s the Executive Director of the Progressive Democrats of America. She is formerly a legislative advocate for the California Nurses’ Association. Donna, as always, we appreciate your expertise. Thank you so much.